Credentialing Specialist *NOT A REMOTE POSITION

Job Description

The Credentialing Specialist is responsible for credentialing physicians, advanced practitioners, chiropractors, radiologists, anesthesiologists, physical therapists, and other clinic positions as appropriate. Responsible for assisting with professional license applications, hospital credentialing, Managed Care contract notifications, provider files for appointment and re-appointment to the Clinic's medical staff, and current certifications as outlined with the Clinic's by-laws.

Job Relationships

Reports to the Onboarding Manager

Principal Responsibilities

• Initiate, establish, and maintain physicians' files for employed Physicians, contracted Physicians, Nurse Practitioners, Physician Assistants, Chiropractors, Anesthesiologists, and Certified Registered Nurse Anesthetists.
• Provide credentialing for medical staff appointment for new Physicians, Chiropractors, Nurse Practitioners, Physician Assistants and Certified Registered Nurse Anesthetists which includes : completed State of Illinois Credentialing Form, the supporting documents (CV, licenses, MD diploma, residency & fellowship certificates, & board certifications), 3 personal references, primary source verification of schooling and data bank inquiry.
• Work with various directors so that appropriate documentation is complete and received to ensure credentialing and re-credentialing of physician is not delayed.
• Provide assistance in helping new physicians apply for hospital privileges, and change their licenses to correct address for DEA or other licenses.
• Provide assistance for physicians in re-appointment paperwork needed by all the area hospitals.
• Provide assistance for nursing home credentialing or re-credentialing paperwork for physicians.
• Complete and follow progress of all managed care credentialing applications and re-credentialing applications in a timely, efficient and professional manner.
• Work closely with managed care plans to maintain accuracy in physician directories.
• Initiate and maintain provider number on IDX.
• Work closely with Transition Team, making sure all appropriate paperwork is submitted to the managed care programs regarding a physician's departure. Any relocation of physician requires notification to all managed care programs with appropriate documentation. Provide assistance in helping the physician obtain correct licenses for relocation.
• Work closely with Patient Accounting department providing support regarding contract questions and other issues that arise. Keeping them updated when credentialing is complete for a physician, along with the effective date for the contract.
• Responsible for accuracy and accessibility of credentialing software.
• Comply with the Springfield Clinic incident reporting policy and procedures.
• Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
• Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
• Perform other job duties as assigned.

Education / Experience

Knowledge, Skills and Abilities

Working Environment

PHI / Privacy Level

HIPAA4